8th May 2013 - A special project in Kent is trying to tackle what the NHS says is the rising number of children who start primary school reception class still wearing nappies.
School nurses and health visitors are working with local nurseries and primary schools to identify children who need help with toilet training as part of the Clean, Dry and Ready for School initiative by Kent Community Health NHS Trust.
"I think when we started the project, we thought it was a little bit of potty training and that was it," health visitor practice teacher Janet Marsh tells us. "It's a much bigger problem than we initially thought it would be, and more widespread."
Teachers were concerned about the number of children who were having accidents. "One of our infant schools had to replace both carpets in their year R [reception] classrooms," says school nurse practice teacher Chris Beer. "They had children who were wetting and soiling. They hadn't been toilet trained."
She says they then tried to find out why the accidents were happening: "Do they have a medical health need that needs to be addressed? Or have they just not hit that milestone, they just haven’t done the toilet training?"
Children with medical problems were given help and others and their parents were supported by school nurses or health visitors "in coming into school clean and dry".
Why isn’t toilet training always happening?
The project team has also been looking at the reasons behind the increase in children who haven't got the hang of knowing when to go to the toilet at school. "We don’t necessarily think it's a gap in parenting," Janet says. "It's a combination of factors."
One reason may be today's nappies are almost too effective: "We were probably terry nappy children. When they became wet, it became uncomfortable. Products these days are fantastic. They have lock away cores, they take up to 800ml in a nappy. The child never has that uncomfortable, wet feeling."
That, she says, can mean a child doesn’t get to know the signals of when to use the toilet.
Children are also starting nursery earlier than they might have done in the past, often before they are toilet trained.
"Nappies go to a much bigger size now," says Chris. "They go up to age 15 these days."
Not drinking enough
It may not appear logical at first, but one reason for the wetting incidents seems to be children not drinking enough. "That's a huge issue," Janet says. "They're usually too busy, they’re not drinking steadily throughout the day.
"They are only having perhaps one or two beakers a day, and they should be drinking about a litre of fluid.
"They don’t get the signs of what a full bladder feels like because they’re not drinking enough."
Not just primary school
The project team has been asked for help for secondary school children. Some children, they say, may have been labelled as having a weak bladder, when their bladder is fine, but toilet training was an issue when they were younger.
"The older the children are, the more difficult it is to manage," says Chris. They're also picking up bowel problems: "We've got lots of children out there who are constipated."
The success of the project is still being evaluated, but could be extended into other parts of Kent and beyond.
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